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Denials Management

Improve Patient Payment Experience With Efficient Denials Management
The rate of claim denials has been on the rise since 2016 and it continues to pose a costly problem to health systems. Not only does it result in lost revenues but also the deteriorating quality of care.

Facts & Figures

11% of the claims are denied on submission.
Denials are costing physicians and hospitals more than $1.6 billion a month.
Over 85% of the denials could be prevented.
Of all denials, close to 67% of them are appealable.

Complex processes have made claims denial management increasingly difficult. In the past, denials management investments have focused on human capital solutions, while the development of technology and process improvements have been lagging. Even with new denials tactics in place, healthcare organizations are struggling to keep pace. They are finding it challenging to implement long-term process changes and deploy personnel effectively to prevent denials. Additionally, unknown financial implications have resulted in acceptance rather than process enhancements or change management.

What is the Solution

We adopt a four-pronged approach to help healthcare organizations address these issues. We ensure that baseline data collection related to current denials is easy and hassle-free so that it is possible to run analytics and uncover important business insights. Next, we support the organizations in charting the denials flow right from receipt to disposition that enables them to create a strong task force and assign specific responsibilities. This robust team would be capable of setting benchmarks, reducing backlogs, and identifying the root cause of denials. Finally, we tap into potential educational opportunities to proactively inform the staff on denials prevention strategies.
Providers should look for a partner that can manage their denials process end to end. This will allow their internal teams to focus on patient experience and care management.

How Innova Can Help

We provide healthcare organizations with a comprehensive denials management solution that encompasses three primary areas of focus— technology and analysis, a solutions-based approach, and an emphasis on outcomes. As we continually check the data and analytics and determine the root cause, we also help the healthcare stakeholders to identify where the denials are occurring in the revenue cycle. This approach helps us to zero in on solutions tailored to the organization’s unique needs. Continuing to prioritize the outcomes our team concentrates on sustainable process improvements that lead to improved financial outcomes and an enhanced care continuum.

Why Innova

Years of experience

Experts in Denials Management

clients have entrusted us with part or all of their denials management process

With the right blend of empowered front-line staff, optimized processes, and integrated technology, we will ensure that you reduce the number of denials. As we draw on the expertise of our professionals who have an in-depth understanding of denials management, we will reduce cash flow bottlenecks and improve your bottom-line.

By collaborating with us you will benefit from:

Streamlined workflows that lead to higher efficiencies, faster appeals, and uninterrupted cashflows.

Useful and specific recommendations for edit improvements, process improvements, and claim management.

Services that reduce regulatory risks and improve compliance.

System-agnostic solutions that resolve the issue of underpayments.

The business model that we follow:

Select team from
our pool of
experienced talent

Integrate our denials management team into your revenue cycle process

Install analytics
package to:

  • Identify trends
  • Recommend education
  • Prevent future denials

Once the Innova team is on board they will manage all denials

  • Determine root cause analysis for each denial
  • Implement corrective action, if possible
  • Track: appeal rate, timely filing deadlines, root cause, corrective actions

Our Approach

Our unique four-phased approach to managing denials is a complete end-to-end process. It will not only identify corrective actions for every denial, but also recommend strategies to prevent future denials.
This step-wise approach combined with our denials analytics platform makes it feasible to manage denials better and reduces their impact on the bottom line. Creating an optimized and effective denials management process requires continuous monitoring and proves invaluable in protecting a healthcare organization’s revenue cycle.

Our Denials Analytics Platform

We leverage automation and AI to provide intelligent solutions that reduce claim denials and ensure a positive ROI. We help healthcare providers deploy AI at each stage of the revenue cycle that minimizes errors, provides insights into denials, and helps avoid significant costs. By leveraging our analytics-powered denials management platform, you can expect reduced revenue loss and improved cash management.
Once we intervene, we will tackle your entire denials management process. We will handle the claim from denial received to resubmission. We will also implement an extensive analytics package to show you patterns and education opportunities to prevent future denials.

Related Services

Reports for Assessment

Appeals Management

Compliance & Security

Meet Our Leaders

Kelly Walton

Kelly Walton

Executive Director of Healthcare Operations

Get in touch with us for feasibility studies, joint workshops, pilots and ideation sessions.


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